• Whedon JM
• Bezdjian S
• Dennis P
• Fischer V
• Russell R

• Acute Pain
• Affiliation / Southern California University of Health Sciences
• Affiliation(G) / United States / California / Whittier
• Affiliation(G) / United States / Minnesota / Plymouth
• Chiropractic / economics
• Chiropractors / United States
• Cohort Studies
• Low Back Pain / statistics and numerical data
• Low Back Pain / therapy
• Manipulation, Spinal / economics
• Open Access Document
• Patient Care

Background: Low back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall. Spinal manipulation as practiced by chiropractors has been found be cost-effective for treatment of LBP, but there is wide variation among chiropractors in their approach to clinical care, and the most cost-effective approach to chiropractic care is uncertain. To date, little has been published regarding the cost effectiveness of different approaches to chiropractic care. Thus, the current study presents a cost comparison between chiropractic approaches for patients with acute or subacute care episodes for low back pain.

Methods: We employed a retrospective cohort design to examine costs of chiropractic care among patients diagnosed with acute or subacute low back pain. The study time period ranged between 07/01/2016 and 12/22/2017. We compared cost outcomes for patients of two cohorts of chiropractors within health care system: Cohort 1) a general network of providers, and Cohort 2) a network providing conservative evidence-based care for rapid resolution of pain. We used generalized linear regression modeling to estimate the comparative influence of demographic and clinical factors on expenditures.

Results: A total of 25,621 unique patients were included in the analyses. The average cost per patient for Cohort 2 (mean allowed amount $252) was lower compared to Cohort 1 (mean allowed amount $326; 0.77, 95% CI 0.75–0.79, p < .001). Patient and clinician related factors such as health plan, provider region, and sex also significantly influenced costs.

Conclusions: This study comprehensively analyzed cost data associated with the chiropractic care of adults with acute or sub-acute low back pain cared by two cohorts of chiropractic physicians. In general, providers in Cohort 2 were found to be significantly associated with lower costs for patient care as compared to Cohort 1. Utilization of a clinical model characterized by a patient-centered clinic approach and standardized, best-practice clinical protocols may offer lower cost when compared to non-standardized clinical approaches to chiropractic care.

Author keywords: Acute or subacute low back pain — Chiropractic care —  Cost comparison —  Patient care

Author affiliations: JMW, SB, RR: Southern California University of Health Sciences, Whittier, California, United States; PD, V-AF: Fulcrum Health, Inc, Plymouth, Minnesota, United States

This abstract is reproduced with the permission of the publisher; click on the above link for free full text. PubMed Record | PDF